Madagascar is a plague-endemic country, with around 300 annual cases of the bubonic form. It is classified as a very high health risk according to the risk assessment and mapping carried out using World Health Organization (WHO) Strategic Tool for Assessing Risk in 2025. In 2017, the country responded to a pulmonary plague outbreak in endemic and non-endemic districts, particularly large urban areas. Every year, the country records sporadic cases and clusters of bubonic plague cases in endemic districts. Infection Prevention and Control (IPC) is a main of control strategies to reduce the risk of disease transmission. The objective is to conduct a retrospective review of a major public health event in order to identify best practices and challenges encountered during the response, with a view to strengthening preparedness, detection, and response capabilities for potential future public health events, according to the Monitoring and Evaluation Framework of the International Health Regulations (2005). Multi-sectoral and After-Action reviews of IPC interventions were organized at national level for the 2017 plague outbreak in Madagascar, in collaboration with the Ministry of Health, others Ministries, technical and financial partners and all stakeholders in the response to epidemics. The WHO methodology was adopted, identifying best practices, lessons learned, challenges and recommendations for IPC. A qualitative and participatory approach was used, employing standardized WHO tools. Good practices include: the deployment of national and international IPC experts; the development of national IPC guidelines, particularly for dead body management; the IPC capacity-building at all levels; disinfection, and environmental sanitation; the installation of community tents as isolation rooms; vector and reservoir control. However, the main difficulties are the implementation of IPC protocols facing to socio-cultural aspects, rumours and social stigmatization; the management of Healthcare-Associated Infections (HAI); and the low level of technical facilities in healthcare establishments. The institutionalization of a national IPC program with core components cares minimum requirements recommended by WHO would be crucial in helping to fight infections and prevent outbreak such as IPC program, Guideline, Education and Training, HAI Surveillance, Multimodal strategies, Monitoring and feedback, Workload staffing & bed occupancy, Built environment, Materials and equipment for IPC.

Plague Outbreak, Infection Prevention and Control, Madagascar